Associations of Plasma Erythritol with Dietary Factors, Cardiometabolic, Inflammatory, and Gut Health Markers in People with and without HIV: A Cross-Sectional Study

Background: Recently, elevated levels of plasma erythritol have been associated with major adverse cardiovascular events (MACE). It is known that people with HIV (PWH) have a higher cardiovascular disease burden. Whether PWH have higher levels of plasma erythritol has not been evaluated. This study aimed to assess if blood erythritol levels are elevated in PWH and to examine relationships between erythritol and dietary, cardiometabolic, inflammatory, and gut health markers. Methods: Plasma erythritol levels were measured using frozen samples from 162 participants, including 109 PWH and 53 people without HIV (PWoH) in a parent study. General linear models were used to assess the linear relationship between characteristics, cardiovascular measures, markers of body composition, inflammation, and gut integrity with plasma erythritol. Logistic regression was used to assess risk factors associated with PWH, and cumulative logit models were used to investigate which factors were associated with having the highest plasma erythritol levels among PWH. Results: Compared to PWoH, PWH had higher plasma erythritol levels (p = 0.03). Every 10% increase in VLDL (p = 0.01), visceral adipose tissue (p < 0.0001), or TNFrI (p = 0.01) was associated with an approximately 1% increase in plasma erythritol. Among PWH, HgbA1c (p = 0.003), TNFrI (p = 0.002), and IFAB-P (p = 0.004) were associated with having the highest tertile of plasma erythritol (>= 3.6 mu M). Compared to PWoH, PWH were more than two times as likely (p = 0.03) to have plasma erythritol >= 3.6 mu M. Conclusions: We identified positive associations between plasma erythritol levels and several factors, including HIV status, BMI, adipose tissue, TNFr1, HbA1c, and VLDL. These results underscore the importance of further investigating the role of elevated plasma erythritol levels in people with HIV, particularly in light of their increased vulnerability to cardiovascular and metabolic diseases.